Family Application Please enable JavaScript in your browser to complete this form.Section 1: Tell Us About You and Your FamilyPARENT’S/GUARDIAN’S NAME *ADDRESSPHONEEMAIL *LEVEL OF EDUCATION COMPLETEDADDRESSPHONEEMAILLEVEL OF EDUCATION COMPLETEDCHILD’S NAMEAGEGRADECHILD’S NAMEAGEGRADECHILD’S NAMEAGEGRADEWDGA’S STUDENT(s) are:Section 2: Your TOP 3 Goals for you and your family:#1: To:#2: To:#3: To:Section 3: Tell Us About Your ChallengesChallengesPlease share with us anything you feel has made it harder for you to fulfill some of your life’s goals...for you individually and/or for your family. Examples would be a single-parent home; bad job situations; conflicts in family relationships; financial concerns; mental health issues; etc.Section 4: What would you like to see happen within your family in the next five years to help achieve your goals?5 years goalsSection 5:WDGA’S 3STEPS2WORK INITIATIVE is initiating FAMILY NIGHT this year. We NEED YOUR FEEDBACK on how to make these events as beneficial to you and your family as possible. Please rate the following topics according to your preference/need, with 1 being the most important and 5, the least important.LayoutMental Health/Depression Selected Value: 1 Co-Parenting Selected Value: 1 Financial Literacy Selected Value: 1 Anger Management/Conflict Resolution Selected Value: 1 Health & Wellness Selected Value: 1 WDGA is committed to involving our youth and their families in Community Projects. What do you believe would help improve Monroeville/Pitcairn/Homestead and surrounding areas?Would you be interested in making a connection with our 3STEPS2WORK families in Kenya?YesNoI believe that our family is eligible for this program and the information I have provided in this application was entirely accurate to the best of my knowledge at the time I completed it. *I AgreeLayoutPRINT NAME *Signature *Clear SignatureTHANK YOU for applying to WDGA’s inaugural 3STEPS2WORK initiative. We’re excited to have you join us!CONFIDENTIALITY AND DISCLAIMER OF LIABILITY:All information related to this application is held in strictest confidence and will be used for the express purpose of WDGA’S initiative. With respect to documents and processing, neither WDGA nor any of its employees, contractors, or volunteers assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, or process disclosed, or represents that its use would not infringe privately owned rights.Submit
